Cranial Basics

Question 1

What is

osteopathic cranial manipulative medicine?

Answer 1

A system of diagnosis and treatment by an osteopathic practitioner using the primary respiratory mechanism and balanced membranous tension.

Question 2

What is primary respiratory mechanism

Answer 2

Primary Respiratory Mechanism = motion that is perceptable throughout the body

• Primary = Fundamental life process
• Respiratory = Motions of head are the breath of life
• Mechanism = Movement of tissue and fluid for a purpose

Question 3

5 components of PRM

Answer 3

1. Inherent mobility of the brain and SC
2. Fluctuation of the CSF
3. Mobility of the intracranial and intraspinal membranes (fascial mobility and continuity significaly impact PRM)
4. Articulatory mobility of the cranial bones
5. Involuntary mobility of the sacrum between the ilia

Question 4

The inherent mobility of the brain and SC is due to what?

Answer 4

Inherent mobility = force acts on brain to cause it to move.

The force = Glial cells, contractile elements in the brain: support cranial motion structurally and physiologically by regulating BF.

• During the inhalation (flexion) the brain (and bony cranium) => shorter and wider.
• During the exhalation phase (extension) the brain (and bony cranium) gets taller and narrower.

Question 5

Glial cells job in supporting cranial motion structually and physiologically by regulating blood flow is seen by what evidence?

Answer 5

Traube-Hering Wave: changes in velocity of blood flow

Question 6

What is the cranial rhythmic impulse (CRI)?

Answer 6

rhymic impulses the skull exhibits

Average = 10 - 14/ minute (ranges 6-14)

Question 7

how do you find the CRI?

Answer 7

1. Palpation: contact the head very light => perform a layer palpation (head => skin => subcutaneous tissue => bone)
2. Must be palpated, cannot see.

Question 8

How does the CRI relate to respiratory and/or circulatory physiologic mechanisms?

Answer 8

Separate, but influenced by them.

If a patient holds their breath => CRI is still palpable

Question 9

Motion characteristics of CRI

R-RADS

Answer 9

R-RADS

1. Rate = 10 -14 bpm
2. Rhythm = regular, subtle like the tide of the ocean.
3. Amplitude: ⬇︎with SD
4. Direction = in healthy ppl = longitudinal and symmetric, but SD => asymmetic.
5. Strength = SD and vitality of pt impacts strength

Question 10

What is the fascia continuity between the head and sacrum, allowing the mobility of intracranial and intraspinal membranes?

Answer 10

Reciprocal tension membrane (RTM) = dural membranes (tentorium, falx cerebelli and cerebri =sutherland fulcrum) that act as a unit and are held under constant tension bc attached to the bones of the vault and base and SC, serving as the “core-link” between the cranium and S2 of the sacrum.

Allows but limits motion: allows for vault to change shape, but holds constant volume

Dura attaches to the occiput and ANTERIOR part of S2 of sacrum

Question 11

What creates the reciprical tension membrane (RTM) and what does it do?

Answer 11

Tentorium + falx cerebri + cerebellum.

Function as a unit and attaches the the bones of the vault and base, holding them under constant tension => lets for change of shape of the vault, while maintaing a contant volume. Allows, but limits motion

Question 12

Main poles of attachment for RTM

1. Anterior/superior pole
2. Anterior/inferior pole
3. Lateral pole
4. Posterior pole

Answer 12

1. Anterior/Superior pole – crista galli
2. Anterior/inferior pole – clinoid processes of sphenoid
3. Lateral pole – mastoid angles of parietals and petrous ridges of temporal bones
4. Posterior pole – internal occipital protuberance and transverse ridges

Question 13

What is a Sutherland fulcrum?

Answer 13

• A point of function/stillness (straight sinus), where motion occurs around.

Question 14

How does the RTM affect motion?

Answer 14

allows, but limits motion

Question 15

Coronal suture

Answer 15

– from R => L, separates the frontal bone from the parietal bones

Question 16

Lambdoidal suture

Answer 16

– from R=> to L, separates the parietal bones from the occipital bone

Question 17

Asterion

Answer 17

where parietal, occipital and temporal bones meet (A is found in the posterior)

Question 18

Occipitomastoid suture

Answer 18

– separates the occipital bone from the temporal bone

Question 19

Parietosquamous suture

Answer 19

from anterior to posterior, separates the parietal bones from the temporal bone and sphenoid bone

Question 20

Sphenosquamous suture

Answer 20

from inferior to superior, separates the sphenoid bone from the temporal bone

Question 21

Sagittal suture

Answer 21

– anterior to posterior, separating the parietal bones

Question 22

Bregma

Answer 22

where the coronal and sagittal sutures meet, anterior of skull

Question 23

Lambda

Answer 23

where the sagittal and lambdoidal sutures meet, posterior of skull

Question 24

Pterion

Answer 24

–where frontal, parietal, sphenoid and temporal bones meet (P is found in the anterior)

Question 25

What is the **SBS (sphenobasilar symphysis)?**

Answer 25

Where the sphenoid bone- occiput come together: Where the [**basisphenoid**] and [**basiocciput**] form a **synchondrosis**, an *almost* immovable joint between the bones, bound by a layer of cartilage.

Question 26

What motions does the **SBS** undergo?

Answer 26

1. **Flexion** 2. **Extension**

Question 27

**SBS Flexion** At the same time, what happens to the sacrum?

Answer 27

* Occurs when we **inhale** **SBS** rises **superior** as the distance ⬇︎ between the _inferior angle of the sphenoid_ and _occiput_. 1. **Sphenoid bone** rotates on a _transverse axis_ moves so that the greater wings move: **ANTERIOR** and **INFERIOR** 2. **Occipput** rotates on a _transverse axis_ so that the occipital squama moves **INFERIOR** and **POSTERIOR;** 3. **Basi-occiput** and **basisphenoid (SBS)** moves **SUPERIOR** **- Sacral base = counternutation (moves into extension)**

Question 28

**_SBS Extension_** At the same time, what happens to the sacrum?

Answer 28

* Occurs when we **exhale** **SBS** move **inferior** as the **distance ⬆︎** between the **inferior angle** of the **sphenoid** and **occiput**. * **Greater wing** moves **superior** and **posteriorly.** * **Occipital squama** moves **superior** and **anteriorly.** * **SBS** move **inferiorly.** **-Sacral base = nutation (**moves into **FLEXION)**

Question 29

**SBS Extension** is paired with what?

Answer 29

**Exhalation:** **Bert**: Elongated head and cheek bones become more prominent.

Question 30

**SBS F**lexion occurs when we _inhale/exhale._ _Type of head?_

Answer 30

**Inhalation** **Wider head**

Question 31

What is the mobility of the **sacrum** between the **ilia**?

Answer 31

**Involuntary, respiratory mobility of the sacrum** due to **PRM** (primary respiratory mechanism) due to the the spinal **dura mater** attaching to the **foramen magnum =\>****posterior body and disc S2.**

Question 32

What is the axis of motion on the **sacrum** due to PRM (respiratory axis)?

Answer 32

**ST Axis (Superior Transverse) at S2.** Passes from side to side through articular process posterior to where it attaches to dura.

Question 33

**SBS** and **sacrum** are linked via the **RTM (dura):** 1. **_Name the motions of the sacrum and the SBS movements that occur with each_**

Answer 33

* **_When SBS extension =\>_** sacrum goes into **_nutation_** = exhalation: base nods anterior "sacrum presses towards heel of hand" * Base = moves anterior/inferior "nodding" * Apex = moves posterior * **_When SBS flexion =\>_** sacrum goes into **_counternutation_** = inhalation: "sacrum presses towards fingertips * Base = moves posterior * Apex = moves anteriorly

Question 34

When SBS sphenoid nods forwards =\> **SBS flexion**, how does the sacral base move?

Answer 34

**Counternutation**

Question 35

Why is sacral motion inherent?

Answer 35

F/E of the occiput due to the **PRM** creates **tractional forces on the dura** =\> and translated to the **sacrum**

Question 36

Name movements if you can feel **sacrum on fingertips**

Answer 36

* **Counternutation** * **​base move posteior** * **SBS flexion** * **Inhalation**

Question 37

Name movements if you can feel sacrum on **heel of hand**

Answer 37

* **Nutation** * **​ base moves anterior** * **SBS extension** * **Exhalation**